Provider Demographics
NPI:1083776447
Name:HUFFMAN, SANDRA K (LPT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-0101
Mailing Address - Country:US
Mailing Address - Phone:419-738-9675
Mailing Address - Fax:
Practice Address - Street 1:410 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-7757
Practice Address - Country:US
Practice Address - Phone:419-738-9675
Practice Address - Fax:567-356-4334
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-03724225100000X
OH003724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0882979Medicaid
OH34169328700OtherWORKERS COMP
OH4508225OtherAETNA
OH650006113OtherRAILROAD MEDICARE
OH000000167400OtherANTHEM
OH738822OtherBUCKEYE COMMUNITY HEALTH